Archives for Global Health

This week child survival is under critical review in Addis Ababa, Ethiopia during the African Leadership for Child Survival – A Promise Renewed summit. This meeting, held at the African Union headquarters and convened by the Ethiopian government along with UNICEF and USAID brought together African Ministers of Health to enter into discussions about markedly improving child survival rates. The summit ends Friday.

Between 1990-2011 child mortality has decreased 39% in sub-Saharan Africa. Photo credit: Mom Bloggers for Social Good

Between 1990-2011 child mortality has decreased 39% in sub-Saharan Africa. According to UNICEF, 1 in 8 children in sub-Saharan Africa die before their fifth birthday from five leading causes: pneumonia, pre-term birth complications, diarrhea, intrapartum-related complications, newborn infection and malaria…continued

Read more to learn which key tweets and infographics are emerging from the summit at the#promise4children hashtag.

Disclaimer: The views expressed are those of theYouth Health and Rights Coalition. They do not necessarily represent the views of the U.S. Agency for International Development nor of the U.S. federal government.

It is often said that young people are our future. But young people aren’t just assets for development tomorrow – they are agents of change today. The first-ever USAID Youth in Development Policy (PDF) clearly recognizes this reality and provides important opportunities to involve global youth in shaping our development agenda and advancing their health and rights.

Young people in Kenya. Photo credit: USAID.

Today’s generation of young people is the largest in history; nearly half of the world’s population—some three billion people—is under the age of 25. Given that this large demographic of young people presents the world with an unprecedented opportunity to accelerate economic development and reduce poverty, the policy is particularly timely and critical. It rightly acknowledges that in order for young people to realize their potential and contribute to the development of countries, they must be able to access information and services that protect their rights and promote their sexual and reproductive health throughout their life span. Advocates, implementers, young people and government partners can help achieve that vision by ensuring that the following important policy provisions are translated into action:

Start early in life

Young people bear a significant burden of poor sexual and reproductive health outcomes, including unmet need for family planning, early marriage and childbearing, maternal death, gender-based violence and HIV. However, when families, communities and nations protect and advance adolescent and youth reproductive rights, young people are empowered to stay healthy and take advantage of education and economic opportunities throughout their lives. We know when these investments happen early in life as well as throughout the life course, they help foster more gender equitable and healthier attitudes and behaviors. So why wait? Let’s embrace the tenets of the policy and invest in young people’s health and rights today.

More money, more tracking

The Youth in Development policy clearly calls for the implementation of evidence-based programs and interventions. The Youth Health and Rights Coalition (PDF) looks forward to supporting this effort with the range of tools and resources developed to effectively implement evidence-based sexual and reproductive health interventions. But we need more than guidance to truly protect and promote the well-being of young people. Advancing youth development will require more funding, better data collection to track investments and outcomes, robust partnerships across sectors, and strong commitment across the agency. It’s a challenge, but one worth taking.

“Nothing about us, without us!”

Many of the young people who are members and partners of the Youth Health and Rights Coalition often call upon this phrase to express the importance of meaningful and ongoing youth engagement, something which is still too often missing in development today. The policy puts the importance of youth participation and engagement front and center of the USAID programming process and emphasizes the need to support more meaningful and equal partnerships with young people while building capacity of local youth-led and youth-serving organizations. USAID’s dedication to civil society consultations to inform the development of the policy was an important first step to put words into action. So let’s keep it up and continue to engage young people as we move forward with the implementation of the policy.

We applaud USAID for recognizing how critical it is to meaningfully engage youth across the diverse countries where the Agency works and look forward to future collaborations. Only together can we succeed in meeting the sexual and reproductive rights and health of all young people and work with them to fulfill their full potential.

The Youth Health and Rights Coalition (PDF) is comprised of advocacy and implementing organizations who, in collaboration with young people and adult allies, are working to advance the sexual and reproductive rights and health of adolescents and youth around the world. The YHRC advocates with key decision makers to prioritize funding and support for comprehensive adolescent and youth sexual and reproductive rights and health policies and practices. Their goal is to ensure young people in the developing world have the sexual and reproductive rights and health information, tools, commodities, and quality services necessary to make healthy and informed choices about their own lives.

Today it was an honor for me to join African colleagues in health and development at the opening of the African Leadership for Child Survival – A Promise Renewed. Minister of Foreign Affairs Tedros Adhanom, Minister of Health Kesetebirhan Admasu, and the rest of the Ethiopian Government should be congratulated for hosting this meeting to accelerate the reduction of Africa’s child mortality rates.

Ethiopia has made great progress in tackling child survival and strengthening their health sector. Since the development of Ethiopia’s first national health policy in the mid-1990s, Ethiopia and the United States Government have partnered to increase and expand access of quality health services to Ethiopians nationwide. The United States is proud to have a long-standing health program in Ethiopia with many of our agencies working in the health sector: CDC, DOD, Peace Corps and my agency, USAID.

Last June, Ethiopia joined India and the United States in cooperation with UNICEF to host a Child Survival Call to Action in Washington. More than 700 global leaders came together and challenged each other to reduce child mortality to 20 deaths per 1,000 births, or lower, in every country around the world by 2035. Assuming countries already making progress continue at their current trends, achieving this rate will save an additional 5.6 million children’s lives every year.

In the last two decades, Sub-Saharan Africa has experienced a 39 percent decline in the under-five mortality rate, a tremendous achievement that has been called part of the “the best story in development.” But despite this progress, we know that some countries are doing better than others. By joining together to share best practices, we can create a strong coalition to help each other’s children live to see their fifth birthdays.

An investment in Africa’s children is an investment in Africa’s future. I am pleased USAID is supporting the African Leadership on Child Survival meeting – and we are committed to being Africa’s partner in this effort for years to come.

School children gathered in Ethiopia. Photo Credit: Nicole Schiegg/USAID

Since 1990, the number of child deaths in sub-Saharan Africa has dropped by 39%. Many African countries are within reach of the 2015 millennium development goal to reduce the under-five mortality rate by two thirds. Yet even with the availability of proven, inexpensive, high-impact interventions for maternal, newborn, and child health, their adoption is slow and high rates of childhood illness and death persist in a number of countries. In sub-Saharan Africa 1 in 8 children die before they reach their fifth birthday.

In an effort to catalyze global action for child survival, the Governments of Ethiopia, India, and the United States together with UNICEF convened the ‘Child Survival Call to Action’ in Washington, D.C. in June 2012. Under the banner of ‘Committing to Child Survival: A Promise Renewed‘, more than 160 governments signed a pledge to renew their commitment to child survival, to eliminate all preventable child mortality in two decades.

To maintain this momentum, the Government of Ethiopia, and former Minister of Health Tedros Adhanom, whose leadership raised Ethiopia’s profile in child survival in the continent, committed to convene the ‘African Leadership for Child Survival—A Promise Renewed’ Meeting January 16-18, 2013, in Addis Ababa, the seat of the African Union.

Ministers of Health from 54 African countries have been invited to come together with peers and global experts to ensure child survival is at the forefront of the social development agendas across the continent and renew the focus of African leaders to head their own country’s efforts and sustain the gains made over the last two decades.

In advance of tomorrow’s African Leadership on Child Survival meeting in Addis Ababa, Ethiopia, the Ministry of Health organized a media site-visit to showcase their community health extension program and its impact on the country’s tremendous reductions in child mortality.

I was taken away from the hustle and bustle of Addis to the Aleltu district, which is north in the Oromia region. The visit began at a health center, then a health post and finally I visited households in a kebele (village). I saw firsthand how the health extension workers along with the voluntary community health promoters, called the “women health development army,” are key to Ethiopia’s health infrastructure. Health extension workers have finished secondary school, or grade 10, and have been through one-year of training that covered 16 components under four categories: family health; disease prevention and control; sanitation and hygiene; and health education. This is called the health extension worker package.

Members of the press interview women at a health center in Mikawa, Ethiopia. Photo credit: Nicole Schiegg

At the health center in Mikawa, the capital of Aleltu, I observed kids getting immunized and women accessing prenatal care. Two women with their newborns in the waiting area agreed to be interviewed by the press. Both commented on how they learned about family planning from the center and how birth spacing leads to healthier children. They planned to wait three years before their next child by using family planning methods offered by the center, which is funded by USAID as part of an Integrated Family Health Program through JSI and Pathfinder International.

At the Wogiti Dera health post, where they focus on maternal and child health in collaboration with the Mikawa health center, I met a 25-year old health extension worker named Mandarin. She showed me charts depicting data from the progress in her village. Practicing what she teaches, Mandarin is one of the women in the village who delivered her baby at the health center. When asked if she aspired to be a doctor, Mandarin replied, “Of course, anything is possible.”

Finally, I visited a household in the Wogiti Dera village, designated a “model household” because it successfully completed a checklist of 16 good behaviors consistent with the 16 components in the health extension worker package. Examples of good behaviors in the package include: women delivering their babies with a skilled birth attendant, children being vaccinated, and the household practicing good sanitation and hygiene.

What was consistent throughout the visit was an emphasis on data to measure impact and performance. This information feeds up to the regional and national level to populate a scorecard to measure Ethiopia’s progress in reducing maternal and child mortality in the region. The community health extension program is one of many best practices that will be shared at this week’s African Leadership on Child Survival meeting.

We like to think of development as a team sport requiring all players to work together toward the same goal. The game gets particularly exciting when you add new players to the team at half time.

Save the Children has served children and families in Nicaragua for almost 80 years. Three years ago, we began partnering with Green Mountain Coffee Roasters Inc. (GMCR), based in Vermont, on a project to increase the income and food security for families of workers on coffee farms. By helping families to diversify their crops, improve storage techniques, and bring crops to market, they can better withstand periods of food scarcity during the months between coffee harvests.

The United States Agency for International Development (USAID) joined the partnership two years ago, adding an ambitious health component through their regional “4th Sector Health” project. Implemented by Abt Associates, 4thSector Health develops public-private partnerships and supports exchanges between countries to advance development through health in Latin America and the Caribbean. In Nicaragua, 4th Sector Health is working with Save the Children and GMCR, along with local civil society partners, to boost maternal and child health and nutrition for the same coffee-growing communities.

USAID’s 4th Sector Health also recently funded an experience sharing trip for Save the Children staff from five Latin American countries, who were involved in implementing GMCR-funded projects. The participants learned from each other’s experiences and are replicating best practices in their own programs, serving to increase their impact and sustainability.

The alliance between USAID, Save the Children, and GMCR is intended to maximize the use of resources and help identify new solutions to challenges affecting these communities. Sometimes the alliance organizations face challenges of their own — coordinating work plans, reporting on technical outcomes, and carrying out their separate missions.

Public-private partnerships, otherwise known as the “Golden Triangle,” are a hot topic in the field of international development. Donors like USAID have invested millions of dollars in partnerships with the private sector, yet some development experts have questioned the development impact of such partnerships in achieving real benefits for the poor and marginalized in developing countries.

As part of its recent reform efforts, USAID has put more attention towards improving its public-private partnership model. For one, USAID is including technical experts in health and nutrition such as Save the Children in some partnerships, recognizing that U.S. civil society groups lend valuable expertise in maternal-child health and other technical areas. Moreover, USAID is steering the private sector towards achievement of concrete development targets through their partnerships, as well as ensuring that companies are held to certain standards, such as respect for workers and environmental stewardship.

From my perspective, this alliance between Save the Children Nicaragua, USAID, and GMCR, is having a transformative impact on the communities in which it operates.

Martha Lorena Diaz is one of many enterprising women working with us,whose partner, Jose Manuel Benavidez, is a coffee farmer on a cooperative that sells to GMCR. Martha was initially given five hens and now keeps 40 in her small business, earning about one dollar a day from selling the eggs and chickens. Save the Children project training sessions have helped Martha to identify nutritious sources of food for her three children, particularly during the lean months when she struggles to provide enough food for them. Martha now makes a corn flour drink to boost her childrens’ daily vitamin intake. Moreover, health promoters, trained by Save the Children, visit her neighborhood and others to monitor child health and nutrition and treat sick children in their communities, which are often far from the closest health center.

Successful partnerships, such as the one between USAID, GMCR, and Save the Children Nicaragua, are critical to achieving lasting results in the communities that we all serve. With an increase in USAID’s partnerships with private sector and NGO players, who are committed to making a real difference in the lives of families in Nicaragua and elsewhere, I believe our team will prevail.

This is part of our FrontLines Year in Review series. This originally appeared in FrontLines May/June 2012 issue as a special section.

Front-line health workers are the first and often the only link to health care for millions of children in the developing world. They are the most immediate and cost-effective way to save lives, and foster a healthier, safer and more prosperous world. The developing world has experienced remarkable declines in maternal, child and infant mortality in recent decades, thanks in large part to the contributions of those who bring the most basic health services and education into the communities of the world’s underserved.

Millions of people are alive today because a midwife was by their side when they gave birth, or they were vaccinated as infants by a nurse, or because their families learned from a community health worker to adopt healthy behaviors like breastfeeding, hand washing, birth spacing and sleeping under a mosquito net.

While progress is being made thanks to the training and deployment of health workers in many countries, there are still too few health workers to reach the millions of families who urgently need care. Millions of children still die every year from preventable causes. The World Health Organization estimates a shortage of at least 1 million front-line health workers, particularly in Africa and parts of Asia.

Community health worker Rosalina Casimiro meets with children in Nampula province, Mozambique, to demonstrate how to purify water prior to drinking. Photo credit: Luisa Chadreque, Pathfinder Nampula

A million more health workers could save many millions more if they had proper training and support.

Many of the interventions that have proven most effective in saving lives require health workers with some kind of training to deliver them. Front-line health workers do not need to be highly educated to be successful. Experience in many countries has shown that health workers with basic schooling plus several weeks of well-designed training, followed by on-the-job supervision, can master the skills needed to diagnose and treat common illnesses, promote lifesaving health practices, and counsel families about family planning, nutrition and hygiene.

Some front-line health workers are midwives, nurses or private providers such as drug-shop dispensers. Many are community health workers who are selected by—and working in—their own communities. To ensure acceptance of these health workers by their communities, they must respond to local norms and customs. Some front-line workers are compensated for their work, either through the formal health system or by the communities they serve; others are volunteers motivated by non-monetary incentives, including flashlights and bicycles, as well as a sense of pride in their work, and increased status in their communities. Many female front-line health workers, in particular, note that their role has helped increase the respect they get from their families, friends and neighbors.

Major killers of children such as diarrhea, pneumonia, malaria and newborn complications can often be prevented or treated close to home by a well-trained health worker who is armed with basic tools and skills, and is part of a functioning health system.

How many die each year?

7.6 million children under 5 die every year, 3.1 million of them during their first month of life.

Major causes of death among children are pneumonia, which causes 1.6 million 1.4 million deaths each year, and diarrhea, which causes 1.3 million 800,000 deaths each year. Malnutrition is estimated to contribute to more than one-third of deaths among children.

“For more than 40 years, USAID has helped children throughout the world grow into healthy, productive adults. Progress in child survival has long been, and remains among the Agency’s major accomplishments,” said USAID’s Deputy Assistant Administrator for Global Health Robert Clay.

USAID-funded initiatives save the lives of approximately 6 million children under 5 each year. The stories from Madagascar, Kenya, Zambia, Mozambique, Bangladesh and Timor-Leste highlight some of the health workers who are saving lives in their communities, and individuals whose lives have been touched—through USAID support—by these saviors on the front lines.

Kathleen Strottman is the Executive Director at the Congressional Coalition on Adoption Institute. Photo Credit: CCAI.

Business giant, Lee Lacocca once said, “The only rock that stays steady, the only institution that works is the family.” This simple, yet profound, principle is one that has not only withstood the test of time but is also the foundation of emerging brain science.

Here is what we know: We know that strong families are the building blocks of strong communities, and strong communities are the building blocks of strong nations. Thanks to leaders like Dr. Jack Shonkoff, we know that relationships with other human beings are not a luxury for children, but an absolute necessity. But you do not need to be a Nobel Prize-winning economist or a world-renowned neurologist at Harvard to be able to recognize that children do best when raised by loving and protective parents. For many of us, we need only to reflect on our own life experience to understand the impact that a loving embrace or encouraging words have in times of stress.

Despite these certainties, millions of children in the world are growing up without the care of a protective and permanent family. These children live in institutions or on the streets; they have been torn from their families because of war or disaster; or they have been bought and sold for sex or labor. And worst yet, the number of children who suffer such fates is rising. For this to change, governments of the world need to not only recognize that children have a basic human right to a family; they must also establish and enforce laws and systems to protect this right. It is for this reason that the Congressional Coalition on Adoption Institute (CCAI) is proud to support the U.S. Government’s Action Plan on Children in Adversity.

Under the plan’s tenets, the millions of children outside of family care will have the opportunity to benefit from programs that prevent them from being separated from their families and quickly reunify them when separation proves inevitable. The Plan also makes the commitment to pursue adoption, foster care, kinship and guardianship for children whose biological families are unable or unwilling to care for them. This is a major step forward and holds promise not only for the futures of children, but the future of nations.

Kathleen Strottman is the Executive Director of the Congressional Coalition on Adoption Institute (CCAI). Prior to working at CCAI, Kathleen served for nearly eight years as a trusted advisor to Senator Mary Landrieu and then as an associate at Patton Boggs, LLC. As the Senator’s Legislative Director, Kathleen worked to pass legislation such as the No Child Left Behind Act, The Medicare Modernization Act, The Inter-Country Adoption Act, The Child Citizenship Act of 2000, The Adoption Tax Credit and the Family Court Act. Throughout her career, Kathleen has worked to increase the opportunity for positive dialogue and the exchange of best practices between the United States and countries such as China, Romania, Russia, Guatemala, Honduras, El Salvador, Ethiopia and India. Kathleen regularly presents at national and international child welfare conferences and has appeared on CNN, FOX News, CBS, NBC, C-SPAN, PBS and numerous other media outlets. She is also a regular contributor to Adoption Today magazine.

The 20th century was marked by dark episodes of violence, repression and mass killing around world especially in Europe. Hitler killed between 11 to 14 million Jews and other minorities, and Stalin was responsible for the death of more than 20 million Soviet citizens. The exact numbers may never be known and the depth of individual suffering is also incomprehensible. Beyond what happened in wars, regimes themselves were responsible for massive human rights violations against their own people. Rule by fear was the order of the day.

On this 2012 International Human Rights Day, the final day of our 16 Days of Activism Against Gender Violence, the countries of the former Soviet Union and Eastern Europe continue to deal with the legacy of that history and continue to come to terms with it. Over the last several years, I have spoken with many USAID Foreign Service Nationals who have told me their stories of what happened to their grandparents or their parents or in some cases in Bosnia harrowing stories of their own families’ ordeals. They pointed out that 20 years ago we never would have been able to have such a conversation. Sadly, at the same time there are still far too many reports of human rights abuses in the region – of those who speak out against corruption, who speak up for their rights and whose political views still sometimes face peril – incarceration, beatings, or even death.

During the darkest times of the Soviet period, people still found a way to express dissent whether openly or through literature, art, and music. The same is true today – people will not be silenced, the human spirit is too strong. This morning I met activists from Belarus to discuss ongoing challenges. In Belarus, the government arbitrarily arrests and imprisons citizens for criticizing officials, for participating in demonstrations and for other political reasons. There are hundreds of politically motivated imprisonments and no accountability for past politically motivated disappearances. And yet brave Belarusians like those I just met continue to seek a way to press for protection of their rights and to improve the lives of their families.

A cadre of human rights activists across the former Soviet Union who devote their lives to bringing human rights protections to every individual remain active. As the Belorussian activists expressed concerns about the conditions of confinement of fellow activists in Belarus, it was clear that even today this is still a perilous endeavor to demand protections for the most fundamental rights. We admire the efforts of these individuals and are reminded of the special place that the U.S. possess in the hearts and minds of the human rights defenders from around the world.

The American people have long stood with repressed people in Europe and Eurasia and around the world. In the 21st Century, we will continue to support those who speak out for universal human rights, freedom and dignity.

Jennifer (Jenny) Albertini is Senior HIV/AIDS Technical Advisor for USAID Africa's Health Team where she focuses on policy, program and technical guidance for the Agency's HIV/AIDS programs in Africa. Jenny has worked with PEPFAR since its inception, including spending seven years in Zambia and Swaziland implementing and managing HIV/AIDS programs there.

Synopsis

For many, childhood is a time of wonder and ambitious dreams to travel to foreign lands and work on issues of social justice.

Often times, such dreams remain unfulfilled – but, not for Peter Piot. As he details in “No Time to Lose: A Life in Pursuit of Deadly Viruses,” more than half of Piot’s life has been spent chasing viruses and politicians around the globe in his effort to understand and mitigate the impact and devastation of infectious diseases.

What started as a mysterious virus delivered to his laboratory in Belgium in 1976 led to his first trip to Africa to pursue what later became known as Ebola. Before he knew it, Piot was partnering with scientists in Africa to investigate other infectious diseases, including sexually transmitted infections, positioning him well for when AIDS began chipping away at the continent in the early 1980’s. He was at the forefront of efforts to unravel what quickly became the newest and fastest growing pandemic. Translating his scientific prowess into bureaucratic-ease, a decade later, Piot helped bring together 10 United Nations agencies to form UNAIDS, the Joint United Nations Programme on HIV/AIDS. UNAIDS was the first UN agency dedicated solely to working on fighting one disease. He led the agency for 14 years (1994-2008).

“No Time to Lose…” isn’t just about the laboratories and boardrooms that Piot was able to grace during his career. As he describes, his relationship with truck drivers and heads of state, physicians and patients, and commercial sex workers and advocates is what pushed him to keep fighting, learning, fundraising, and advocating for those affected with infectious diseases for more than thirty years. These relationships still drive him, and this book is as much a reflection of his career in global health as it is an expression of his respect for the people who have been most affected around the world.

Review

Piot’s book is not just a clinical review of infectious diseases – in fact, in the context of his narrative, Ebola or HIV & AIDS could have gone by any other name. What matters – and where Piot devotes much of his prose – is the impact that these diseases have had on the fabric of societies, and how the themes of poverty, family and governance radiate throughout all of their (and our) lives. He was able to connect the science uncovered in the laboratories with the faces of the patients he saw in clinics from Brussels to Kinshasa – and throughout the world. Perhaps most importantly, his book brings these stories to the world leaders he lobbied for so many years to do more to advance efforts to fight HIV & AIDS in their countries. He was not always successful at moving them towards action, but he always tried. And, his persistence is palpable through the pages.

I first saw Peter Piot in a nightclub in Rio during the International AIDS Society conference of 2005. As a self-proclaimed “public health nerd,” it was practically a celebrity sighting to see such an esteemed man dancing with the rest of us mere mortals. The results of a successful male circumcision trial in South Africa had been released that day and there was buzz in the air about this highly efficacious prevention intervention. It felt good to take a deep breath and celebrate a win for once.

One of my favorite quotes from Piot, as he describes AIDS, is, “This time, I knew, we were looking at the worst epidemic I could imagine, the greatest assailant I would ever face, something that would absorb all the energy that I could throw at it, and far more. In my mother tongue, Dutch, I wrote in my notebook: Incredible. A catastrophe for Africa. This is what I want to work on. It will change everything.”

A lot of progress has been made since that catastrophe first started 30 years ago. We are now – hopefully – on a path towards creating an AIDS-free generation. As we commemorate World AIDS Day this year, a review of Piot’s book seems most timely. It allows us to reflect on where we have been and how far we have come, but it also serves as an impetus to keep moving towards our goal with a sense that there is ‘no time to lose.’

Discussion Questions

Although Piot lobbied South African President Mbeki repeatedly to change his way of addressing HIV/AIDS in his country, years went by before real change happened as the epidemic grew worse. Was there anything Piot could have done differently to have moved Mbeki into action earlier?

Certain African leaders (like Festus Mogae of Botswana) have been outspoken champions on HIV/AIDS. What are the characteristics or drivers which have made them positive leaders and what would it take for more of their peers to also take on these efforts?

Did the creation of UNAIDS serve (one of) its intended purpose of focusing UN efforts around a single disease to achieve maximum impact, or would they have made more of an impact utilizing their existing platforms?

Several recent articles have focused on balancing career and family, like Anne-Marie Slaughter’s piece “Why Women Still Can’t Have It all.” Piot mentions his family rarely in this book, although the birth of his children coincided with the beginning of the initial Ebola and AIDS outbreaks and he speaks volumes about his incessant travelling, late nights at work, etc. What are the differences that would have been experienced by a woman taking on Piot’s role at the time he worked on these issues? What, if anything, would be different now?